<%= render "navbar"%>

<div class="container submit_order_title_container">
  <h1 class="submit_order_title">申请退款</h1>
</div>

<div class="container order_container">
  <div class="row">
    <div class="col-md-7 col-xs-12 class_info_section">
      <img src="http://7i7g8l.com1.z0.glb.clouddn.com/71947e46a1de9cbbcfb1399b42ec350d40be4818-39bff560f4e5f675dd5b45e1dbdfa8eef27ee080.png" alt="" class="order_pic">
      <div class="order_info">
        <p class="price"><span class="price_num">100.00元</span>/课时</p>
        <h2 class="class_name">雅思强化班</h2>
        <p class="class_desc">雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班雅思强化班</p>
      </div>
    </div>
    <div class="col-md-4 col-xs-12 submit_form_section refund_form_section">
      <h4>写退款说明.........</h4>
      <form>
        <div class="form-group">
          <label for="reason" class="control-label">请选择退款原因:</label><br> 
          <select name="reason" id="reason">
            <option value="">我不想上了</option>
            <option value="">课程太贵</option>
            <option value="">距离太远</option>
            <option value="">交通不便利</option>
            <option value="">对课程/机构不满意  </option>
            <option value="">对西瓜校园服务不满意</option>
            <option value="">其他 </option>
          </select>
        </div>
        <div class="form-group">
          <label class="control-label">退款金额：</label>
          <p><span class="num">1000</span>元</p>
        </div>
        <div class="form-group">
          <label for="remark" class="control-label">退款说明：</label>
          <textarea type="tel" class="form-control" name="remark"></textarea> 
        </div>
        
        <div class="form-group">
          <button type="submit" class="btn btn-default">提交</button>
        </div>
      </form>
    </div>
  </div>
</div>